Updated Global Burden of Cholera in Endemic Countries

Abstract

BackgroundThe global burden of cholera is largely unknown because the majority of cases are not reported. The low reporting can be attributed to limited capacity of epidemiological surveillance and laboratories, as well as social, political, and economic disincentives for reporting. We previously estimated 2.8 million cases and 91,000 deaths annually due to cholera in 51 endemic countries. A major limitation in our previous estimate was that the endemic and non-endemic countries were defined based on the countries’ reported cholera cases. We overcame the limitation with the use of a spatial modelling technique in defining endemic countries, and accordingly updated the estimates of the global burden of cholera.Methods/Principal FindingsCountries were classified as cholera endemic, cholera non-endemic, or cholera-free based on whether a spatial regression model predicted an incidence rate over a certain threshold in at least three of five years (2008-2012). The at-risk populations were calculated for each country based on the percent of the country without sustainable access to improved sanitation facilities. Incidence rates from population-based published studies were used to calculate the estimated annual number of cases in endemic countries. The number of annual cholera deaths was calculated using inverse variance-weighted average case-fatality rate (CFRs) from literature-based CFR estimates. We found that approximately 1.3 billion people are at risk for cholera in endemic countries. An estimated 2.86 million cholera cases (uncertainty range: 1.3m-4.0m) occur annually in endemic countries. Among these cases, there are an estimated 95,000 deaths (uncertainty range: 21,000-143,000).Conclusion/SignificanceThe global burden of cholera remains high. Sub-Saharan Africa accounts for the majority of this burden. Our findings can inform programmatic decision-making for cholera control.

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

“…[13][14][15][16][17][18][19][20] A study in urban Dhaka, Bangladesh, found that household members of cholera patients had more than a 100 times higher risk of a cholera infection than the general population during the 1-week period after the presentation of the index cholera patient at the hospital. 21,22 Consistent with this finding, a recent study in rural Bangladesh found that the odds of a Shigella infection were 44 times higher for household members of pediatric shigellosis patient during this 1-week window. 23 Similar findings have also been observed for enterotoxigenic Escherichia coli.…”

El Niño and the shifting geography of cholera in Africa

“…Although evidence suggests there are country-specific reporting biases for cholera that lead to both overestimation of cholera incidence during some epidemics and the underestimation of true cholera incidence in other settings (24), as long as these biases are not temporally variable they should not influence the association of cholera with ENSO. However, if the size of outbreaks are systematically underreported, then the magnitude of the shift in cholera incidence during El Niño events may be underestimated due to missed cases.…”

Engineering Microbial Physiology with Synthetic Polymers: Cationic Polymers Induce Biofilm Formation inVibrio choleraeand Downregulate the Expression of Virulence Genes

“…cholerae is a Gram-negative bacterium responsible for several million incidences of gastrointestinal disease and up to 142,000 deaths every year. 17,18 Within the human host, the bacterium initiates a virulence programme including the induction of colonisation factors and toxins, in response to the chemical and physical cues experienced during colonisation and adhesion. In aquatic environments, V. cholerae persists by forming biofilms on the surfaces of phytoplankton, zooplankton and chitin debris.…”